Provider Demographics
NPI:1538635255
Name:DANIEL, TIMOTHY PETER (AGACNP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PETER
Last Name:DANIEL
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 JONES MILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:GA
Mailing Address - Zip Code:30293-2772
Mailing Address - Country:US
Mailing Address - Phone:770-712-0729
Mailing Address - Fax:
Practice Address - Street 1:64A JONES MILL RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:GA
Practice Address - Zip Code:30293-2678
Practice Address - Country:US
Practice Address - Phone:706-553-5367
Practice Address - Fax:705-553-5370
Is Sole Proprietor?:No
Enumeration Date:2018-10-20
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235633363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner